Describing an old trick in posterior thoracal and lumbar ımplant removal surgery: follow-up results for at least 10 years

TL;DR

This paper presents a new surgical technique for removing thoracolumbar implants with long-term follow-up results showing effectiveness and safety.

Contribution

A novel surgical approach for posterior thoracolumbar implant removal is introduced and evaluated over a decade.

Findings

The novel technique avoided clinical symptom progression in all patients.

Screw removal was successful even in cases with screw–screwdriver mismatch.

Major complications were not observed postoperatively.

Abstract

Retrospective case series.

We aimed to describe with a novel surgical approach for the removal of posterior thoracolumbar implant in patients with symptomatic failure of the implant and present our preliminary results with this method.

This retrospective, single-center study was performed in the neurosurgery department of a university hospital. Data were gathered from the medical files of 314 patients (243 women, 77.39%; 71 men, 22.61%) with symptomatic thoracolumbar implant failure that underwent implant removal operation using our novel technique between 2010 and 2020. Symptoms, radiological findings, intraoperative findings as well as clinical outcomes were evaluated.

In our series, the average age was 46.5 years (range: 21–84) with a mean follow-up duration of 7 years (range: 3 months to 10 years). Preoperatively, the most common symptoms were leg pain and numbness of the lower extremity. Postoperatively, no major complications were noted. Clinical progression of symptoms was avoided by surgery in all patients, while we came across removal difficulties due to screw–screwdriver mismatch in 15 of 314 surgeries (4.78%). Our novel approach allowed successful screw removal including these challenging cases.

We suggest that our novel approach is a practical and effective for the removal of posterior thoracolumbar implant in cases with symptomatic failure attributed to screw–screwdriver mismatch. Further trials are warranted to assess the efficacy of this technique to overcome surgical problems associated with screw removal.

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